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Sri Lanka: Action against dengue beginning to pay off

Sri Lanka is making progress in the battle against mosquito-borne dengue fever, say health officials.

“Over the last two years we have gone all out to stop the spread of dengue,” Pabha Palihawadana, head of the Health Ministry’s Epidemiology Unit, told IRIN. “Now we are seeing some of the results.”

In 2011, 26,722 cases were reported - down from 34,105 cases in 2010 - the Health Ministry reported. The number of deaths dropped from 246 to 172.

Dengue infections rose suddenly in 2009, when 35,000 infections were reported - an almost six-fold rise on 2008 when there were 6,607 cases. This prompted the authorities to take action, but the number of infections continued at a high level. “That is when we knew we needed help,” Palihawadana said.

In May 2010, an anti-dengue Presidential Task Force - involving the ministries of health, defence, the environment, education, and local government, and headed by Sri Lankan President Mahinda Rajapaksa - was set up and a massive community prevention campaign launched using billboards, TV advertising and even schoolchildren to raise awareness.

At the same time, military and civil defence forces began cleaning up areas suspected of being mosquito breeding grounds. Dumping rubbish in unauthorized locations became a criminal offence with fines of up to US$40; and public health inspectors began visiting homes in search of potential breeding places.

“It was with the fines and the environmental police that we saw the tide beginning to shift,” Palihawadana explained.

Urban areas have been particularly susceptible to dengue: In 2011, nearly 15,000 infections and 115 deaths were reported in Western Province, the island’s most populous region and home to the country’s largest city, Colombo. Other urbanized districts with high rates of infection include Kandy (1,553), Galle (831) and Rathnapura (1,078).

The Presidential Task Force has so far set up over 15,300 committees at district and village level dedicated to dengue eradication.

Health Ministry spokesman W. M. D. Wanninayake explained that until the task force was set up dengue was considered a medical problem, but “with the task force it is now a national priority”.

Zapping the larvae

Imports, and local production, of Bacillus Thuriengiensis (BTI), a bacteria used to control dengue vector larvae, were stepped up. BTI was released in breeding grounds in high-risk areas, while at the same time efforts were made to boost training for health workers, and set up dedicated dengue treatment facilities in at least 50 hospitals.

Health experts from Thailand were brought in to train senior health professionals who then cascaded the training down to district level.

Speedier referrals for patients with haemorrhagic fever have helped reduce the number of fatalities.

“We have to commend the government of Sri Lanka for adjusting the national management guidelines for dengue patients when admitted to hospital,” Kumari Navaratne, a public health specialist at the World Bank said. “This has drastically reduced the complications of dengue patients while in hospital and therefore reduced the case fatality rate.”

The government is currently drafting a National Dengue Prevention Act, due to become law in mid-2012, Wanninayake said.

Under the new legislation, the authorities will be allowed to impose spot fines of up to US$400 and jail terms of six months on anyone who fails to clean up potential breeding areas.

According to the World Health Organization, there is no effective vaccine against dengue, or drug treatment for those who become infected - and there are an estimated 50 million dengue infections worldwide each year.